The objective of this research is to create a clinical prototype of a new optical coherence tomography (OCT) system suitable for diagnostic retinal imaging at the point of care. The target system price will be one third the price of currently available research OCT systems while providing performance comparable to other entry level OCT imaging systems. By breaking the $15,000 system barrier we will provide an incisive tool that will be disruptive to the market by making OCT accessible to clinics and health care professionals who previously could not afford this technology. We have spoken with ophthalmologists and optometrists who confirm the need for a low-cost portable system in the detection and monitoring of diabetic retinopathy, glaucoma, retinopathy of prematurity, and macular degeneration. Increased access to OCT can have a profound effect in ophthalmology. By significantly reducing instrument cost, this OCT system will be affordable for retinal screening at the point of care and in a wide range of research applications. This price point also opens markets in developing countries where the value of clinical OCT is understood, but currently clinical systems are too expensive. The research plan, proposed here, will create a prototype of the low cost OCT instrument suitable for clinical ophthalmic use. We propose to achieve the following milestones: (1) Improve design of low cost OCT. We will transition from off-the-shelf to custom parts to reduce system cost and improve performance over the Phase I prototype including increasing the A-scan rate to 80,000 lines per second. (2) Integrate OCT with handheld fundus camera. Our market research shows that this capability is important for clinical acceptability. (3) Develop new software for instrument control and image analysis. We will transition our software from Windows to Linux-based to increase performance. New image analysis packages will be developed with aid of a collaborator. (4) Test system on human subjects. Clinical performance will be assessed in a small clinical feasibility trial with our collaborator, Dr. Ulrich at the UNC Kittner eye center.